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Optimal assessment of paediatric IBD with MRI and barium follow-through
Edward Giles1, Ozan Hanci, Alison McLean
1Department of Paediatric Gastroenterology, Barts and The London Children's Hospital, London, United Kingdom. e.m.giles@qmul.ac.uk
Insights
Magnetic resonance imaging (MRI) is a superior diagnostic tool for pediatric inflammatory bowel disease (IBD) compared to barium follow-through (BaFT). MRI offers higher sensitivity and specificity for detecting ileal pathology with no radiation exposure.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Imaging
- Inflammatory Bowel Disease (IBD)
Background:
- Current UK standard for pediatric IBD diagnosis involves barium follow-through (BaFT), which uses radiation and unpalatable contrast agents.
- Magnetic resonance imaging (MRI) is increasingly used for Crohn disease (CD) investigation.
Purpose of the Study:
- To compare the diagnostic efficacy of BaFT and a novel abdominal MRI protocol in pediatric IBD patients.
- To evaluate MRI as a potential criterion standard for pediatric IBD assessment.
Main Methods:
- A cohort of 87 pediatric IBD patients underwent both abdominal MRI and BaFT.
- Radiologists compared MRI and BaFT reports, with case note review and histology as the criterion standard for terminal ileal disease.
Main Results:
- MRI identified additional pathology in 31% of patients not seen with BaFT.
- MRI demonstrated higher sensitivity (83% vs. 76%) and specificity (95% vs. 67%) for terminal ileal disease compared to BaFT.
- 67% of patients had equivalent findings between MRI and BaFT.
Conclusions:
- Abdominal MRI is at least equivalent to BaFT for diagnosing pediatric IBD.
- MRI offers superior sensitivity and specificity for terminal ileal pathology.
- MRI should be considered the criterion standard for pediatric IBD investigation due to its diagnostic accuracy and lack of radiation exposure.
Objectives:
The present UK criterion standard for assessing children with suspected inflammatory bowel disease (IBD) is upper endoscopy, ileocolonoscopy, and barium follow-through (BaFT). Significant doses of radiation, unpalatable contrast, and volume intolerance are involved with BaFT. Practice in investigating Crohn disease (CD) is changing with the increasing use of magnetic resonance imaging (MRI). The aim of the present study was to compare BaFT and a new abdominal MRI protocol in a paediatric IBD population.
Methods:
All consecutive patients with a new diagnosis of IBD or requiring reassessment from September 2008 to December 2010 were investigated with both abdominal MRI and BaFT in accordance with a specific local paediatric IBD protocol. The studies were reported by nonblinded radiologists with an interest in gastrointestinal imaging. The reports were compared in conjunction with case note review.
Results:
Eighty-seven patients underwent both BaFT and MRI abdomen. Thirty-one percent of patients had additional pathology on MRI, not seen on the BaFT. Sixty-seven percent of patients (n=59) had an MRI finding equivalent to BaFT. Using histology as a criterion standard for detecting terminal ileal disease, BaFT had a sensitivity and specificity of 76% and 67%, and MRI had a sensitivity and specificity of 83% and 95%, respectively.
Conclusions:
This is the largest series of small bowel MRI in a paediatric population. MRI reports were at least equivalent to BaFT. MRI had higher sensitivity and, particularly, specificity in detecting terminal ileal pathology. These findings suggest that MRI should become the criterion standard investigation in children with IBD in centres with appropriate expertise, with zero radiation exposure being highly advantageous.
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